ALCOHOL & OTHER DRUGS

1 ALCOHOL & OTHER DRUGSA BASWPOCKETGUIDEF ully revised& updatedEssential Information for Social DO s & DON TsDON T assumethat OTHER professionals will haveassessed for ALCOHOL and drug problemsDON T be afraid to ask; social work is all about dealingwith sensitive personal issuesDON T worryif you don t understand what people sayabout ALCOHOL they can explainDON T be judgemental; nobody starts using DRUGS ordrinking intending to develop a problemDON T tell people to stop; stopping use withoutspecialist input can be dangerous even fatal particularly with alcoholDO expectthere to be prejudice and stigma associatedwith ALCOHOL and drug usersDO remember that even brief interventions from front-line workers have proved to help people changeDO routinely address ALCOHOL and OTHER drug more you practise the better you ll get andremember anyone might be affectedDO your best to view ALCOHOL and drug use in its widercontext: is it making any problems worse or is it helpingto reduce them?

2 2 ALCOHOL , DRUGS & SOCIAL WORKS ocial workers are in the front line of health and socialcare services. ALCOHOL and OTHER drug use can play asignificant role in the lives of people who receive socialwork recipients have the right to professional socialcare, delivered by well-trained, well-supervisedworkers. Social workers should be able to interveneconfidently and effectively where they encounteralcohol and drug and OTHER drug problems have not always beenhigh on the social work agenda. It is now recognisedthat core social work skills are ideally suited for workwith people s ALCOHOL and drug : people seeking help for these issues may bedescribed as being in Recovery . this does notalways mean they are or need to be pocket guide seeks to support social workers totake professional responsibility for ensuring their knowledge and skills meet the needs of service recipients with ALCOHOL and drug problemsFirst published in 2010 this revisededition is published by BASW, & IDENTIFYING PROBLEMSS ocial workers routinely assess the full range of needspeople have but may be less informed on ALCOHOL andother drug issues.

3 If this key area of need is missed andnot met, interventions for OTHER issues will not be and using DRUGS are associated with manyproblems familiar to social workers. Those problemsare not necessarily caused by the use of ALCOHOL ordrugs but that use may complicate the picture. Routine,individual assessment is therefore essential. While there may be evidence of ALCOHOL or OTHER druguse in some cases there is no magic checklist of signsor symptoms to spot . Routinely asking sensitivequestions is a vital skilled approach. Specialist websitesprovide access to basic information on ALCOHOL anddrugs (see Sources of Information).The values and skills social workers deploy inconducting comprehensive assessments are thoseneeded to assess ALCOHOL and OTHER drug problems. ALCOHOL and drug issues have been neglected in socialwork training and education.

4 The BASW Pocket Guideseries seeks to redress this WITH ALCOHOL & DRUGSDRUGS:people frequently forget to ask about DRUGS ,including prescription DRUGS . If drug use is identified it iseasy to be distracted by it. Drug use is only ever part ofthe picture. The person s behaviour and experiencesneed to be assessed as a : drinking is so common it may simply beoverlooked, especially when there are OTHER obviousproblems. Because ALCOHOL use is the norm, it shouldalways be addressed. Many drug users have even worseproblems with S NOT MY JOB: ALCOHOL and drug use are soprevalent among vulnerable service users that workingwith them is everybody s job. You do not have to be aspecialist but do need enough to identify any issues,conduct an initial assessment and consult or make areferral to an appropriate IT ON:when referring people on to specialistservices, it is essential to ensure that everyoneunderstands what services the social worker willcontinue to offer and COMMON PITFALLS5 WORKING WITH ALCOHOL & DRUGSC hanging problematic ALCOHOL or drug use can be hard,psychologically and physically.

5 People often resistexternally imposed changes. They can and do makechanges with the right support and motivation. The Stages of Changeis a model that helps explain theprocess of behaviour change (Prochaska & DiClemente1983, 1994). Change is understood as a progressionfrom Precontemplation, Contemplation, Preparation,Action, Maintenance and so on. A key concept is that change rarely works first from previous attempts can improve thechances of success. If an attempt has not worked staffcan build motivation at every stage to try 1: A Spiral Model of the Stages of ChangeNote: Adapted from InSearch of How PeopleChange: Applications ofAddictive Behaviours , by J OProchaska, CC DiClemente,JC Norcross, 1992, AmercianPsychological Association,47,p1104. Copyright 1992 bythe American PsychologicalAssociation. Adapted FRAMEWORK FOR HELPINGFRAMES is a model from an evidence-based approach.

6 Motivational InterviewingFeedback on the ALCOHOL and drug use must beaccurate and positiveResponsibility - be clear that the choiceto change andresponsibility for it rests with the individualAdvice giving give clear information & adviceMenu always offer a choice of change optionsEmpathy an empathic style is essentialSelf-efficacy promote independenceWORKING WITH SPECIALIST SERVICESl Ask for advice & information on ALCOHOL and otherdrugs, services available & referral proceduresl Establish their capacity and willingness to conductjoint assessments and joint interviewsl Establish information sharing boundaries beforestarting workl Offer mutual support training exchangesl With agreement, consider three-way meetings withservice recipients & specialist servicesl Maintain regular communication and meetings withcolleagues in specialist services7 ASSESSMENT & INTERVENTION: ALCOHOLA lcohol consumption is counted in UnitsUnits can help work out how much we drink.

7 Countingunits can help with cutting down. Units can also helpassess the severity of any ALCOHOL Medical Officers guideline for women and men: lIt is safest not to drink regularly more than 14 unitsper week, to keep health risks to a low level. lIf you drink 14 units per week it is best to spread thisover 3 days or more: heavy drinking increases risksfrom long term illness accidents and risk of developing illness ( mouth, throat &breast cancers) increases with any amount you drinkon a regular basis. lIf you wish to cut down your drinking, a good way isto have several drink-free days each of beer usually = units; standard pub wineglass = 2 units - large wine = 3 units; bottle of wine =9-10 units; single 25ml pub spirits = 1 unit. People tend to pour bigger measures at ALCOHOL Units information: & INTERVENTION: ALCOHOLH elping people talk about their drinking or drug use isabout asking the right questions in the right way.

8 Toneof voice and an empathic approach are crucial. Onceyou understand units you can ask the followingquestions:Women: Do you ever drink more than 6 units a day?Men: Do you ever drink more than 8 units a day?If they answer Neverthey are unlikely to have analcohol problem . To explore in more depth:There may be locally agreed ALCOHOL screening &assessment tools in place: find out. They can helpsocial workers work in partnership with specialistagencies. Specialist ALCOHOL services can also be asource of free advice and guidance to s no harm in asking. Ensure you are familiar withlocal ALCOHOL referral pathways and does your drinking help you?lDoes drinking ever cause problems for you?lWould you like to change your drinking?lHave you successfully made changes before?lHow confident are you that you could changeyour drinking?

9 LWhat help do you need to change?9 ASSESSMENT & INTERVENTION: DRUGSThe social worker may be the first professional to askabout drug issues. They can play a key role in helpingpeople with drug related information to ask about includes:Slang is often used to describe DRUGS . If you don tunderstand ask the person to explain. Thisacknowledges the person s expertise and offers arespectful empowering local areas have agreed drug questionnaires toscreen and initially assess drug problems. There willalso be specialist drug referral pathways. If you don tknow about these check with managers or localspecialist drug services. Specialist ALCOHOL and drugtreatment are now often provided by the same line workers should know where to refer foralcohol and for are people using?lHow much are they using?lHow often do they use?lHow do they use (smoke, swallow, inject)?

10 LWhat are the effects for them positive &negative of using DRUGS ?lWhat happens if they stop using?10 ASSESSMENT & INTERVENTION: DRUGSWith illegal drug use people may be wary of tellingofficials what they use. An assertive, empathic socialwork approach can be questions that may help include:People respond differently to different DRUGS atdifferent times. Don t assume you know the effects adrug will have on someone. Always ask information and trends in drug use can alsochange rapidly. Local specialist services can be asource of up-to-date information and for drug services can also change quiteregularly. Make sure you know who the current ALCOHOL & drug service providers are; what they offer yourparticular client group and how your services can worktogether. Remember, partnership working often startswith frontline do you want from your drug use?